Severe malaria associated acute respiratory distress syndrome: a case report

Background: Severe malaria is known to have multisystemic effects involving the brain, the kidneys, and occasionally the lungs, causing acute lung injury and, a part of the spectrum, acute respiratory distress syndrome. Aim: To report a case of severe malaria associated with acute respiratory distress syndrome in a Nigerian teenager. Methods: Electronic medical records at the emergency unit, the female ward, and the intensive care unit provided all the details about the patient’s clinical course for this report. Case Report: A 15-year-old girl presented to the A&E with a fever and vague abdominal pain. Malaria parasite test was negative. Urinary tract infection was suspected, empirical antibiotics were initiated, with little relief. The fever persisted and a repeat malaria test on the second day was positive. Oral antimalarial medication was administered on an outpatient basis. She represented later the same day with fever and respiratory distress. Laboratory test showed thrombocytopaenia. Chest radiograph showed bilateral lung infiltrates. Antibiotics were continued, and oxygen supplementation with no relief. The next day, dyspnoea worsened, with severe hypoxaemia. This necessitated intensive care unit admission. Non-invasive mechanical ventilation (continuous positive airway pressure ventilation) and parenteral artesunate were initiated and given for four days with full recovery. Conclusion: Severe malaria from plasmodium falciparum with associated acute respiratory distress syndrome (ARDS) can occur with high morbidity and mortality. This necessitates prompt recognition, intervention, and early intensive care unit admission, initiation of continuous positive airway pressure ventilation (CPAP), and intravenous antimalarial treatment for a good outcome.